General anaesthesia for enteroscopy: A look at patient-reported experience measures
F. O'Hara, C.Costigan, C.Walker, A.O'Connor, S.O'Donnell, N.Breslin, B.Ryan, D.McNamara
Tallaght University Hospital TAGG, Department of Medicine, Trinity College Dublin
Device Assisted Enteroscopy (DAE) is a time-consuming and invasive procedure. A BSG, JAG, and RCoA joint position statement highlights patient intolerance as an important factor in procedure success and recommends considering deep sedation for protracted and complex endoscopic procedures. Tallaght Hospital performs DAE under both general anaesthesia (GA) and conscious sedation (CS). DAE under CS has been shown to need higher doses of fentanyl and midazolam to maintain acceptable patient comfort in comparison to other endoscopic procedures. Deeper levels of sedation likely offer a significant procedural advantage and improved patient experience. We looked at patient-reported experience measures(PREM), an important measure of quality, for patients undergoing DAE using Endoprem, a recently validated PREM for endoscopy.
To assess the patient-reported experience of DAE under GA and CS.
Patients attending for DAE were asked to complete an Endoprem questionnaire post-procedure. Procedure data were also recorded. Comparisons were made between those having GA and CS.
35 patients (response rate = 66%) returned completed questionnaires (GA = 14 and CS = 19). Overall satisfaction scores were excellent in both groups at 100%. However, in the CS group, discomfort during procedure was experienced by 47.4%, while 21.1% experienced moderate to severe pain. 26.3% of CS patients experienced more pain than they expected. Mean midazolam and fentanyl doses were 5.3mg and 69.0mg respectively in the CS group. Discomfort post-procedure was similar between both groups 21.1% (CS) vs 21.4% (GA), p=1.00. When demographics were examined GA procedures were performed on younger patients, 60yrs (CS) vs 41yrs (GA). Indication differences were also noted between the 2 groups with anaemia the main indication in 57.9% (CS) vs 7.1% (GA), p=0.004. GA procedures were more likely to have a targeted intervention in mind, 92.9% (GA)vs 42.1% (CS), p=0.004.
Patients have high satisfaction for DAE performed under GA. Significant discomfort and pain were experienced in the CS group with many experiencing pain greater than expected. Selection of more complex DAE procedures for GA will likely improve patient experience measures.